Treatments and outcomes of older patients with esophageal cancer: Comparison with younger patients

Matsumoto, Yoshihisa; Kimura, Kazuyoshi; Zhou, Qichang; Sasaki, Kenta; Saiki, Tadahiko; Matsushima, Masato; Saijo, Yasuo

doi:10.3892/mco.2019.1909

Cited by 10 publications

(8 citation statements)

References 20 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in a previous propensity score-matched study, patients with T1N0 EC who underwent local therapy had similar overall survival but improved EC-specific survival compared with those who underwent oesophagectomy, which meant that local therapy may reduce procedure-related death (9). In addition, Matsumoto and colleagues performed a single centre retrospective study and found that the prognosis following oesophagectomy was not better than that of chemoradiotherapy in elderly patients with stage I EC (18). Accordingly, the assessment of surgical tolerance among patients with pT1a stage EC who have potentially lifelimiting medical conditions or comorbidities was critical, and palliative chemoradiotherapy or local therapy may be considered as treatment options for this population (4,9,18).…”

Section: Discussionmentioning

confidence: 99%

Development of a predictive nomogram for cause-specific mortality in surgically resected early-stage oesophageal cancer: a Surveillance, Epidemiology, and End Results (SEER) analysis

Yu¹,

Gao²,

Xue³

et al. 2020

J Thorac Dis

View full text Add to dashboard Cite

Background: The aim of this population-based study was to perform competing risk analysis and estimate cancer-and other cause-specific mortality in patients who underwent oesophagectomy with pT1N0M0 oesophageal cancer (EC). A competing risks nomogram was also developed to predict the proportional of death from each specific cause.Methods: A total of 1,144 patients who received oesophagectomy for pT1N0M0 EC between 2010 and 2015 from SEER database were included. The cumulative incidence function was used to evaluate each cause of death, and the significant difference was assessed by the Grey's test. A nomogram was established using the proportional subdistribution hazard analysis to identify predictors for each cause-specific death. Results:The 5-year cumulative incidence of cancer-specific death for surgically resected pT1N0M0 EC was 15.7%, and the incidence was 11.2% for other cause-specific death. Age, tumour length, pT1 substage, grade, history and primary site were identified as predictive factors for EC-specific death, but only age, tumor length and pT1 substage were associated with death from other cause. Our nomograms showed a relative good discriminative ability, with c-index of 0.663 for the EC-specific mortality model and 0.699 for the other cause-specific mortality model. The calibration curves showed a good match between the nomogram-predicted probabilities and the actual probabilities. Conclusions: In patients who underwent curative-intent resection for pT1N0M0 EC, death from other causes was an important competing event. During clinical decision making and patient-clinician communication, our quantifiable nomograms could provide a rapid and precise judgement of the risk of death from each cause.

show abstract

Section: Discussionmentioning

confidence: 99%

Development of a predictive nomogram for cause-specific mortality in surgically resected early-stage oesophageal cancer: a Surveillance, Epidemiology, and End Results (SEER) analysis

Yu¹,

Gao²,

Xue³

et al. 2020

J Thorac Dis

View full text Add to dashboard Cite

show abstract

“…Age per se should not be the sole factor for or against trimodal therapy [ 43 – 46 ]. Scoring systems like P-POSSUM or O-POSSUM and predictive models as published by Steyerberg et al and, more recently, by the International Esodata Study group should be considered by stratifying our patients for more or less aggressive therapy regimens [ 47 – 50 ].…”

Section: Discussionmentioning

confidence: 99%

Chemoradiation for elderly patients (≥ 65 years) with esophageal cancer: a retrospective single-center analysis

et al. 2022

View full text Add to dashboard Cite

Background Present studies on the efficacy and safety of curative chemoradiation therapy (CRT) with esophageal cancer reflect heterogenous results especially in elderly patients. The aim of this study was to evaluate the toxicity and efficacy of CRT in patients ≥ 65 years. In a cohort, the focus centered around treatment-related toxicity (CTCAE Grade > 3), overall survival as well as progression free survival, comparing these rates in-between patients older than 70 years to those younger than 70 years. Methods A total of 67 patients older than 65 years (34 (50.7%) were older than 70 years) met the inclusion criteria for retrospective analysis (period from January 2013 to October 2017). Treatment consisted of radiotherapy and chemotherapy with carboplatin/paclitaxel or fluorouracil (5-FU)/cisplatin with the intention of neoadjuvant or definite chemoradiation. A sum of 67 patients received CRT (44 (65.6%) patients in neoadjuvant, 23 (34.4%) in definite intent). Of these, 22 and 12 patients were older than 70 years (50% and 52.2% in both treatment groups, respectively). Median age was 71 years and patients had a good physical performance status (ECOG 0: 57.6%, ECOG 1: 27.3%). Median follow-up was 24 months. Most patients had advanced tumour stages (T3 stage: n = 51, 79.7%) and nodal metastasis (N1 stage: n = 54, 88.5%). A subgroup comparison was conducted between patients aged ≤ 70 years and > 70 years. Results In severe (CTCAE Grade 3–5) toxicities (acute and late), no significant differences were observed between both patient groups (< 70 years vs. > 70 years). 21% had acute grade 3 events, 4 patients (4%) had grade 4 events, and two patients (3%) had one grade 5 event. Late toxicity after CRT was grade 1 in 13 patients (22%), grade 2 in two (3%), grade 3 in two (3%), grade 4 in four (7%), and grade 5 in one (2%). Median overall survival (OS) of all patients was 30 months and median progression-free survival (PFS) was 16 months. No significant differences were seen for OS (32 months vs. 25 months; p = 0.632) and PFS (16 months vs. 12 months; p = 0.696) between older patients treated with curative intent and younger ones. Trimodal therapy significantly prolonged both OS and PFS (p = 0.005; p = 0.018), regardless of age. Conclusion CRT in elderly patients (≥ 65 years) with esophageal cancer is feasible and effective. Numbers for acute and late toxicities can be compared to cohorts of younger patients (< 65 years) with EC who received the same therapies. Age at treatment initiation alone should not be the determining factor. Instead, functional status, risk of treatment-related morbidities, life expectancy and patient´s preferences should factor into the choice of therapy.

show abstract

“…Surgical treatment of EC is increasingly accepted for elderly people defined as aged over 70 years. Not differing outcome and long-term results in the selected elderly from those reported for younger patients offer the possibility of risk/opportunity stratification and assessment [47][48][49][50]. Here, based on a comparison of the CROSS trial with historical controls (e.g., RTOG 8501 and Intergroup [INT] 0123) and retrospective studies, radiosensitizing with Carb/TAX seems more tolerable than cisplatin/5-fluorouracil [51][52][53].…”

Section: Discussionmentioning

confidence: 99%

The Role of Age and Comorbidities in Esophagogastric Cancer Chemoradiation of the Frail Elderly (>70 Years): An Analysis from a Tertiary High Volume-Center

Linde

Mallmann

Adams

et al. 2022

Cancers

View full text Add to dashboard Cite

Elderly patients >70 years of age with esophageal cancer (EC) represent a challenging group as frailty and comorbidities need to be considered. The aim of this retrospective study was to evaluate the efficacy and side effects of curative chemoradiation therapy (CRT) with regard to basic geriatric screening in elderly patients in order to elucidate prognostic factors. Thirty-four elderly patients > 70 years with EC treated at our cancer center between May 2014 and October 2018 fulfilled the selection criteria for this retrospective analysis. Treatment consisted of intravenous infusion of carboplatin/paclitaxel or fluorouracil (5-FU)/cisplatin with the intention of neoadjuvant or definite chemoradiation. Clinicopathological data including performance status (ECOG), (age-adjusted) Charlson comorbidity index (CCI), Frailty-scale by Fried, Mini Nutritional Assessment Short Form, body mass index, C-reactive protein to albumin ratio, and treatment-related toxicity (CTCAE) were assessed. Data were analyzed as predictors of overall survival (OS) and progression-free survival (PFS). All patients (ten female, 24 male) received combined CRT (22 patients in neoadjuvant, 12 patients in definite intent). Median age was 75 years and the ECOG index between 0 and 1 (52.9% vs. 35.3%); four patients were rated as ECOG 3 (11.8%). Median follow-up was 24 months. Tumors were mainly located in the lower esophagus or esophagogastric-junction with an T3 stage (n = 25; 75.8%) and N1 stage (n = 28; 90.3%). 15 patients (44.1%) had SCC, 19 patients (55.9%) AC. 26 of the patients (76.5%) were scored as prefrail and 50% were in risk for malnutrition (n = 17). In relation to the BMI, ten patients (29.4%) were ranked as overweight, and 15 patients were presented in a healthy state of weight (44.1%). Grade 3 acute toxicity (or higher) occured in nine cases (26.5%). Most of the patients did not show any late toxicities (66.7%). Trimodal therapy provides a significant prolonged OS (p = 0.049) regardless of age, but without impact on PFS. Our analysis suggests that chemoradiation therapy is feasible for elderly patients (>70 years) with tolerable toxicity. Trimodal therapy of EC shows a positive effect on OS and PFS. Further studies are needed to elucidate benefitting subgroups within the elderly. In addition to age, treatment decisions should be based on performance status, nutritional condition and multidisciplinary validated geriatric screening tools.

show abstract

Treatments and outcomes of older patients with esophageal cancer: Comparison with younger patients

Cited by 10 publications

References 20 publications

Development of a predictive nomogram for cause-specific mortality in surgically resected early-stage oesophageal cancer: a Surveillance, Epidemiology, and End Results (SEER) analysis

Development of a predictive nomogram for cause-specific mortality in surgically resected early-stage oesophageal cancer: a Surveillance, Epidemiology, and End Results (SEER) analysis

Chemoradiation for elderly patients (≥ 65 years) with esophageal cancer: a retrospective single-center analysis

The Role of Age and Comorbidities in Esophagogastric Cancer Chemoradiation of the Frail Elderly (>70 Years): An Analysis from a Tertiary High Volume-Center

Contact Info

Product

Resources

About